Myra Powers Email & Phone Number

Ucare

• Provide review of medical documentation against criteria requirement for the purposes of determining coverage of select services for medical necessity, and approval of coverage when criteria is met• Claims adjustments, provider education, provider grievance resolution along with the use of multiple computer systems, and ongoing education of Medicare and Medicaid criteria • Review initial and concurrent requests for hospital and skilled nursing home admissions through dischargeAugust 2010 – April 2012: Restricted Recipient Nurse, UCareo Promoted to temporary position as a case manager with in the restricted recipient members program and their assigned providers with special consideration to complex mental health needs of this chemically dependent populationo Worked with the Department of Human Services to supervise members who have inappropriately utilized their medical benefits o Position also involved review of claims and program regulations via the Department of Human Services and Minnesota Health Plan policies and procedures

Minneapolis, Mn

• Produce clinical summaries of medical records and provided expert opinion regarding causation• Create exhibits for trial, created demand letters and negotiated claims• Improved process for screening/interviewing clients reducing time spent on non-meritorious cases• Optimize current software capabilities to reduce medical record search and lobbied outsourced vendor to integrate additional research data bases

August 2004 – September 2006: Epic Support Staff Nurse, Codeblue Medical Staffing, Minneapolis, Minnesota• Hired by Health Partners to assist with their transitional phase to electronic medical records (EMR)• Trained on-site medical staff to utilize EpicCare with charting, billing and system communications• Role required to assist physicians, providers and nursing staff at all clinic locations with patients and procedures • Worked in conjunction with a multitude of language translators due to our diverse patient populations

• Hired by Health Partners to assist with their transitional phase to electronic medical records (EMR)• Trained on-site medical staff to utilize EpicCare with charting, billing and system communications• Role required to assist physicians, providers and nursing staff at all clinic locations with patients and procedures • Worked in conjunction with a multitude of language translators due to our diverse patient populations

Subcontracted to perform independent case review and analysis. Responsibilities included review of medical records and submission of a written summary and analysis of pertinent medical findings. This process required but was not limited to determine medical necessity and relevance to surgical and medical intervention resulting in subsequent effective patient care and treatment. This position allowed my nursing skills to be utilized in a completely different manner from traditional nursing thus helping to broaden my knowledge base within the ever expanding medical and legal nursing field. I will hold my experience with PetersonReed as an invaluable experience and will continue to miss the opportunities and challenges of which this position offered me.

• Conducted on-site medical chart review for external audit in accordance with the NCQA• Chart audit and submission of copies of any significant findings to inquiring health plans- A submission of daily data reports and e-mail communications with the Hedis• Personally was selected as the Minnesota representative for Q-Mark Hedisheip, but due to lack of full-time employment guarantee, I declined 2005-2007 audit position

• Primary role was to provide direct assistance to clinic OB/GYN physicians• Responsibilities included the following: completion of patient history, patient education, and preparations of rooms for procedures and medical procedures, and administration of injections• Additionally, responsible for scheduling surgeries, medical procedures, phone triage and preparing patient charts for provider review. e to a difficult pregnancy.

As, Nursing

Activities and Societies: Phi Theta Kappa Working toward my AS degree in Nursing through the Mobility program at NHCC with a anticipated.

Nursing Diploma, Nursing

Activities and Societies: Graduated in 1998 with a 3.82 GPA